解剖を基礎にした三叉神経痛の手術

Microvascular Decompression Surgery for Trigeminal Neuralgia: Technical Review Based on Surgical Anatomy

Ⅰ．はじめに

　血管圧迫による特発性三叉神経痛（以下三叉神経痛）の手術を行うにあたって必要な手術解剖について概説する．三叉神経痛は痛みのために患者をひどく苦しめるものではあるが，直接には生命にかかわらない病気である．本疾患に対する微小血管減圧術は，確立された手技であるとはいえ，大きなシリーズで死亡率0.3％との報告もあり⁷⁾，また種々の合併症の報告もある．また前医での不適切な手技によると思われる再発もしばしば経験する．きちんとした手技で安全，確実に手術を行わなくてはならない．

　To perform secure microvascular decompression for trigeminal neuralgia, it is important to perform each surgical procedure based on detailed anatomical knowledge. As for microsurgical procedure, there are two major approaches; the supracerebellar approach and the trans-horizontal fissure approach. This article reviews the advantages of each surgical approach and describes points to pay attention to, with figures which will help the surgeon to perform this surgery. The importance of real decompression or transposition of the offending vessels is stressed. The significance of preoperative imaging as well as perioperative management including the patients’ positioning is also described.